The invasion of
French North Africa on 8 November 1942 was the first action of World War
II by U.S. ground forces against the European Axis. The beaches of Morocco
and Algeria and the rugged mountains and barren wastes of Tunisia were
the testing grounds both for the combat forces and for the medical troops
that supported them in the field and behind the lines. It was in North
Africa that officers, nurses, and enlisted men of the Army Medical Department
perfected the techniques and developed the organizations that were to save
thousands of lives in Italy and France.

Prelude to Invasion

Genesis of the North
African Campaign

As early as January
1942, when Prime Minister Winston S. Churchill and his Chief of Staff,
General Sir Alan Brooke, were in Washington for high-level strategic discussions,
the possibility of launching an Allied military campaign in northwest Africa
was suggested, but resources available at that time were clearly inadequate
for such an undertaking. The matter was again discussed in June, in connection
with the dangerous situation on the Russian front and the precarious position
of the British forces in Africa, where the Germans had been halted barely
short of Cairo. In July, the Combined Chiefs of Staff in London, under
strong pressure from the President, made the decision to mount the operation
at the earliest possible date. D-day was later set for 8 November. Allied
landings in Morocco and Algeria were to be co-ordinated with a planned
offensive by the British Eighth Army, to be launched from the El 'Alamein
line in the fall. Lt. Gen. Dwight D. Eisenhower was designated to command
the operation, known by the code name TORCH, and was directed to begin
planning at once. Allied Force Headquarters (AFHQ) for the North African
campaign was set up at Norfolk House in London in mid-August, with primary
responsibility for planning delegated to Maj. Gen. Mark W. Clark, Eisenhower's
deputy commander.1

1 Sources
for the genesis and military planning of TORCH are: (1) Biennial
Report of the Chief of Staff of the United States Army, July 1, 1941 to
June 30, 1943, to the Secretary of War (Washington, 1943), pp. 18-20;
(2) History of Allied Force Headquarters, August 1942-December 1942, vol.
I; (3) Winston S. Churchill,
The Hinge of Fate (Boston: Houghton
Muffin Company, 1950); (4) Dwight D. Eisenhower, Crusade in Europe
(Garden City, New York: Doubleday and Company, 1948); (5) Mark W.
Clark, Calculated Risk
(New York: Harper and Brothers, 1950); (6)
George F. Howe, Northwest Africa: Seizing the Initiative in the West,
UNITED
STATES ARMY IN WORLD WAR II (Washington, 1957); (7) Craven and Cate,
eds., Europe:
TORCH to POINTBLANK; (8) Leo J. Meyer,
"The Decision To Invade North Africa (TORCH)," Command Decisions
(Washington,
1960), pp. 173ff; (9) Samuel Eliot Morison "History of United States
Naval Operations in World War II, vol. II, Operations in North African
Waters, October 1942-June 1943
(Boston: Little, Brown and Company,
1950). pp. 3-42, 181-186.

105

The strategical
and psychological importance of the operation can scarcely be overestimated.
A successful TORCH would relieve the hard-pressed Russians by opening a
diversionary front much earlier than an invasion of continental Europe
could be launched; it would forestall the possibility of a German breakthrough
into the oil-rich Middle East to join hands with the Japanese; it would
open the Mediterranean to Allied shipping and render more secure the sea
and air routes over the South Atlantic; it would put U.S. ground troops
into action against the Germans; and, finally, if it could be accomplished
without fatally embittering the French, it would open the way for France
to re-enter the war on the Allied side. By the same reasoning, however,
the venture was hazardous. To fail would spell disaster.

Plans for Operation
TORCH

The plans developed
by General Clark and his collaborators called for simultaneous landings
at three separate points. British naval units were to support operations
inside the Mediterranean; U.S. units those in the Atlantic. The Twelfth
U.S. Air Force, under command of Brig. Gen. James H. Doolittle, was activated
and trained to give necessary air support as soon as airfields could be
captured and made operational.

The Western Task
Force, which was to storm the beaches on the Atlantic coast of Morocco
in the vicinity of Casablanca, was commanded by Maj. Gen. George S. Patton,
Jr. Totaling approximately 34,000 men, it consisted of the 2d Armored Division,
the 3d Infantry Division, and two regimental combat teams of the 9th Infantry
Division. The Western Task Force trained in the United States and sailed
for Africa under convoy of the U.S. Navy.

The Center Task
Force, under command of Maj. Gen. Lloyd R. Fredendall, was to go ashore
on beaches flanking Oran, some 250 miles inside the Mediterranean. This
force was made up of elements of II Corps, built around the 1st Infantry
Division, half of the 1st Armored Division, and a force from the 509th
Parachute Infantry Regiment, reinforced by corps troops to a strength of
more than 40,000. The Center Task Force trained in England and was convoyed
by British warships.

The Eastern Task
Force, with a complement of 23,000 British and 10,000 U.S. troops and commanded
by Lt. Gen. K.A. N. Anderson of the British First Army, was to attack Algiers.
Maj. Gen. Charles W. Ryder, commander of the 34th Infantry Division, led
the American element, which consisted of two reinforced regimental combat
teams (RCT), one each from the 9th and 34th Infantry Divisions, and a Ranger
battalion. Like the Center force, the Eastern Task Force trained in England
and was accompanied to its destination by units of the British Navy. In
the hope of securing more willing co-operation from the French, who were
still resentful toward their former British allies for the earlier sinking
of French vessels at Oran, General Ryder and his American troops were to
spearhead the Eastern Task Force assault.

Both personnel
and equipment for medical support of the task forces were to be held to
the absolute minimum. The medical section of Allied Force Head-

quarters was headed by a British
Director of Medical Services, Brigadier, (later Maj. Gen.) Ernest M. Cowell.
The ranking American medical officers were Cowell's deputy, Col. John F.
Corby, and Corby's executive officer, Lt. Col. (later Col.) Earle Standlee.
The decentralized nature of the operation, however, placed primary responsibility
for planning and organizing combat medical support on the task force surgeons.
Col. Richard T. Arnest, II Corps surgeon, conducted planning for the Center
Task Force in England, while Col. (later Maj. Gen.) Albert W. Kenner, surgeon
of the Western Task Force, worked in Washington. Medical service for the
Eastern Task Force was planned and largely supplied by the British, the
force surgeon being the Deputy Director of Medical Services of the British
First Army, Brigadier E. W. Wade. Each force surgeon operated pretty much
on his own, within a broad policy framework; there was little or no co-ordination
between the forces. The Twelfth Air Force surgeon, Col. Richard E. Elvins,
functioned independently of both AFHQ and the task force surgeons in the
preparation of medical plans, including plans for air evacuation.2

From the medical
point of view, the North African campaign was difficult and largely extemporized.
The distances were vast: 445 miles by air from Casablanca to Oran; 230
miles from Oran to Algiers; and another 400 air miles from Algiers to the
ultimate objective, the Tunisian ports of Tunis and Bizerte. By way of
the antiquated, single-tracked rail line that connected the coastal cities,
the distances were considerably greater. Highways were few in number and
poor in quality, not built to withstand the punishment inflicted by tanks
and heavily loaded trucks moving in steady streams from ports to supply
depots and to the fighting fronts. Water was scarce and always subject
to suspicion; sanitation was primitive; malaria, typhus, dysentery, cholera,
and venereal diseases were known to be widely prevalent, with plague a
constant threat in the seaports. All of these factors had to be taken into
account in medical preparations for the invasion and for the subsequent
campaign in Tunisia.

2 General
sources for medical planning of Operation TORCH, in addition to general
sources cited above, are: (1) 2d Lt. Glenn Clift, MS, Field Operations
of the Medical Department in the Mediterranean Theater of Operations, United
States Army (hereafter cited as Clift, Field Opns) pp. 1-20; (2)
Hist of the Twelfth Air Force Med Sec, Aug 42-Jun 44; (3) F. A. E.
Crew, "History of the Second World War," The Army Medical Services:
Campaigns
(London: Her Majesty's Stationery Office, 1957) vol. II;
(4) Link and Coleman, Medical Support of the Army Air Forces in World
War II, pp. 419-24.

Planning for the
initial assault also had to take into account a shortage of shipping space
that would limit supplies and restrict medical support to little more than
could be given by the divisional medical units organic to the participating
formations. For the U.S. increment, supplies were to be in the form of
the standard medical maintenance units, each sufficient to support 10,000
men for thirty days, augmented by special drugs and biologicals appropriate
to the conditions anticipated.

In bed strength
the Eastern Task Force, which was to lead the advance into Tunisia, fared
better than either of the other landing groups. In addition to the organic
units, the D-day troop list included a British field ambulance, comparable
to an American clearing company; 2 light casualty clearing stations (200
beds each), equivalent to small evacuation hospitals, each with a field
transfusion unit and 2 field surgical units attached; 2 British general
hospitals, more mobile than their U.S. counterparts, of 600 beds each;
and 4 teams of the U.S. 2d Auxiliary Surgical Group, with enlisted men
substituted for nurses. Beds would thus be available for about 4.8 percent
of the command during the first four days. The second convoy, which was
to reach Algiers on D plus 4, was to carry 2 British general hospitals
of 200 beds each and one of 1,200 beds, but the ratio would not be raised
since troop strength would also be doubled by that time.

The Center Task
Force was to carry two hospitals in the assault--the 400-bed 48th Surgical
and the 750-bed 38th Evacuation--or beds for less than 3 percent of the
command. Another 750-bed unit, the 77th Evacuation Hospital, was scheduled
for the second convoy, which would reach Oran on D plus 3 along with the
51st Medical Battalion, but a 50-percent increase in troop strength would
keep the bed ratio barely above 3 percent.

For the Western
Task Force, sailing from the United States, shipping was even more restricted,
and no hospitals of any kind were included in the D-day troop list. Since
the second convoy for the Western Task Force was not due for several days,
transports were to be supplied with equipment and personnel to serve as
floating hospitals during the first days of the assault.

In each of the
landing operations the Navy--British or American--was to be responsible
for all medical care between the port of embarkation and high water on
the landing beaches, and naval beach groups were to help in the collection
and care of casualties. British hospital ships

108

were to evacuate patients from Algiers
and Oran to the United Kingdom. Since no U.S. hospital ships were available,
there would be no alternative for the Western Task Force but to evacuate
casualties by returning transports or hold them ashore for future disposition.

Plans for combat
medical service in the landing phase were spelled out in considerable detail,
but were based largely upon manuals prepared without realistic knowledge
of amphibious operations. Participation by U.S. observers in the costly
Dieppe raid of 19 August 1942 was the nearest approach to a seaborne landing
on a hostile shore in modern U.S. Army experience.3 It is therefore
not surprising that casualty estimates were too high, or that conditions
under which medical troops would operate were misjudged.

Medical Support
in the Landing Phase

The Allied assault
on the Moroccan and Algerian coasts took place as scheduled in the early
hours of 8 November 1942. It was hoped that the French would not resist
the landings. Secret negotiations to this end were carried on right up
to D-day itself, climaxed by a personal appeal from President Roosevelt,
which was broadcast in French over shortwave radio as the troops began
to go ashore. On most of the beaches, the first waves of combat troops
did get ashore without encountering more than sporadic small arms fire,
but before objectives were gained there was fighting in every sector.

Eastern Task Force

Algiers was first
to surrender, owing largely to secret contacts with military commanders
there and to the unexpected presence in the city of Admiral Jean-Francois
Darlan, Vichy naval commander, whose authority was second only to that
of Marshal Henri Pétain himself. The city lies along the western
rim of a half-moon-shaped bay, whose eastern extremity is Cap Matifou.
Seven or eight miles west of the city the coast dips sharply to the south,
interrupted only by Cap Sidi Ferruch, which juts into the Mediterranean
on a line with the center of Algiers and about ten miles distant.4(Map
6)

The 39th Regimental
Combat Team of the 9th Division, with elements of the British 1st Commando
attached, went ashore east of Cap Matifon in the early hours of 8 November.
Landing craft used were small and fragile by later standards, and boat
crews were inexperienced. It is not surprising, therefore, that many of
them piled up in the surf and others

were brought ashore at the wrong
beaches. Aside from sporadic fire from coastal batteries on Cap Matifou,
however, no opposition was encountered at the beaches, and the combat team
quickly pressed inland and captured Maison Blanche airfield.

The 168th RCT
of the 34th Infantry Division and the bulk of the British 1st Commando
landed just north of Cap Sidi Ferruch, but here, too, the invaders were
widely scattered because of faulty navigation. Only the absence of opposition
enabled the force to regroup and move inland toward Algiers by daylight.
The commandos, meanwhile, had received the surrender of the fort at Sidi
Ferruch without a fight, and, with the aid of friendly French officers,
the airfield at Blida had been neutralized. The British 11 Infantry Brigade
landed without opposition some twenty miles south of Cap Sidi Ferruch simultaneously
with the more northerly landings and moved inland to protect the flank
of the 168th RCT.

The only seriously
opposed landings were those of the 6th Commando north and west of Algiers,
where difficulties in assembling and loading the assault boats delayed
the landings until after daylight. Here the commandos had to call for the

110

support of naval gunfire and of carrier-based
planes to win their objective by late afternoon. An attempt by two British
destroyers to enter the harbor before dawn had proved unsuccessful. One
of the vessels was forced to withdraw after suffering severe damage from
shore batteries. The other succeeded in ramming the boom and landing a
detachment of the 135th RCT, 34th Division, but the troops were pinned
down and taken prisoner, while the destroyer withdrew so severely damaged
that she later sank.

By late afternoon
of D-day Algiers was surrounded, its airfields were in the hands of the
Allies, and those of its coastal fortifications that had not capitulated
were at the mercy of Allied naval guns and bombers. Darlan, who had been
in contact with Robert Murphy, the U.S. diplomatic representative in North
Africa since the eve of the landings, met with General Ryder early in the
evening and agreed to a local cease-fire. After two days of negotiation
an armistice was signed, to be effective shortly after noon on 11 November.
Negotiations continued until 13 November, when Darlan was recognized as
de
facto
head of the French Government in North Africa.

In addition to
its own medical detachment, each of the U.S. regimental combat teams that
spearheaded the Algiers landings was accompanied by a collecting company
and a clearing platoon of the medical battalion organic to its parent division--Company
A and the 2d Platoon of Company D, 9th Medical Battalion, with the 39th
RCT; and Company C and the 2d Platoon of Company D, 109th Medical Battalion,
with the 168th.

On the beaches
east of Cap Matifou, where the 39th RCT made its landings, the collecting
company was put ashore during the morning of D-day, but most of its equipment
remained on shipboard. Without vehicles to follow the combat troops and
with little in the way of medical supplies, the company remained of necessity
close to the landing area in the vicinity of the beach dressing station
set up by British naval personnel. Casualties were held at the dressing
station because the sea was too rough to permit evacuation to the ships
and no hospital facilities were available on shore.

A radio call for
more medical personnel early in the afternoon brought Capt. (later Maj.)
Paul L. Dent and Capt. (later Maj.) William K. Mansfield of Surgical Team
No. 1, commanding officer and executive, respectively, of the 2d Auxiliary
Surgical Group detachment, to the beach about 1600, but they were unable
to bring equipment with them. A bombing raid, rough seas, and the coming
of darkness prevented the landing of more surgical group personnel or of
the clearing station they were to support, so Captains Dent and Mansfield
worked through the night at the naval beach dressing station.

The quick end
of hostilities on the 8th enabled the two surgical group officers to evacuate
more than twenty patients the next morning to the dispensary at Maison
Blanche airfield about fifteen miles inland, using trucks and borrowed
French ambulances. The clearing platoon of the 9th Medical Battalion and
the remaining eighteen officers and enlisted technicians of the 2d Auxiliary
Surgical Group did not come ashore until 11 November, when the ships carrying
them docked at Algiers. A hospital was then set up in a schoolhouse in
Maison Carrée, about midway between the air-

111

field and Algiers. On 13 November
the hospital moved to Fort de l'Eau on the bay north of Maison Blanche,
where it was operated jointly by the collecting company and the clearing
platoon of the 9th Medical Battalion and the four surgical teams.

On the beaches
west of Algiers, where the 168th RCT landed, the first collecting company
personnel came ashore at 0730 on D-day, but were landed at the wrong beach
and were forced to make a 10-mile march carrying equipment on litters to
reach the battalion aid station they were to support. The clearing platoon,
meanwhile, had landed at 0800, and set up station in conjunction with the
British 159th Field Ambulance in the basement of a winery near Sidi Ferruch.

The remainder
of the collecting company came ashore about 1,000, but the only ambulance
to be unloaded on D-day was not available until evening and did not reach
the forward station until 0900, D plus 1. A British surgical team joined
the clearing station on 9 November. Later that day the clearing platoon
and the field ambulance took over the Mustapha civil hospital in Algiers,
which quickly expanded from 100 to 300 beds, functioning as an evacuation
hospital.

Fortunately, there
were few casualties on D-day when the medical service in landing areas
would not have been prepared to deal adequately with them. Most of those
occurring in the next few days resulted from German bombings and from land
mines. Only 93 U.S. soldiers were hospitalized during the first week of
the Algiers campaign. Of these, 58 were admitted for battle wounds, 13
for injuries, and 22 for disease.5

Center Task Force

In the central
sector the strategy employed by General Fredendall was in all respects
similar to that used by the Eastern Task Force. Like Algiers, Oran lies
on a crescent-shaped bay, protected by headlands on either side. Here the
strong-points were the fortified military harbor at Mers el Kebir, three
miles west of Oran; and the town of Arzew, twenty-five miles to the east.
Both positions were outflanked.6 (Map 7)

One armored column,
comprising about one-third of Combat Command B,

5 Rpt. Hq
S0S ETO, Off of the Chief Surgeon, 15 Feb 43. These figures cannot be fully
reconciled with those given in the Final Report, Army Battle Casualties
and Nonbattle Deaths in World War II. The official tabulation shows 1,017
U.S. Army (including Air Forces) personnel wounded or injured in action
for the whole North African theater for the month of November 1942. The
combined wounded and injured figure for the three task forces for the week
of 8-14 November as given in the document cited above is 1,224. The time
is relatively comparable, since U.S. forces were not engaged before 8 November
or during the remainder of the month after 14 November. The larger figure
in the S0S report is presumably owing to the inclusion of some naval personnel
in the Western Task Force figures, but these are not separable. Hospital
admissions for injury in the TORCH operation were not differentiated as
to battle or nonbattle origin.
6 Combat
sources for the Center Task Force are: (1) Opns Rpt, Center Task
Force; (2) Howe, Northwest Africa; (3) H. R. Knickelbocker
and others,
Danger Forward: The Story of the First Division in World
War II (Washington: Infantry Journal Press, 1947); (4) George
F. Howe, The Battle History of the 1st Armored Division, "Old Ironsides"
(Washington:
Combat Forces Press, 1954); (5) Morison, North African
Waters.
Medical sources primarily relied upon are: (6) Annual
Rpt, Surg, II Corps, 1942; (7) After Action Rpt, 1st Med Bn, 20 Nov
42; (8) Hist, 47th Armd Med Bn, 1 Oct 42-9 May 43; (9) Annual
Rpt, 48th Surg Hosp, 1942; (10) Annual Rpt, 38th Evac Hosp, 1942;
(11) Clift, Field Opns, pp. 40-48. See also, (12) Ltr, Col Rollin L. Bauchspies
to Col Coates, 15 Apr 59, commenting on preliminary draft of this volume.

1st Armored Division, landed some
thirty miles west of Oran. The landing was unopposed, but difficulties
in getting the vehicles ashore delayed any advance until about 0900. The
column then struck eastward to Lourmel and followed the north rim of the
Sebkra d'Oran, the long salt lake that parallels the coast about ten miles
inland. Against only sporadic opposition, the column reached and seized
La Sénia airfield, south of Oran, on the morning of 9 November.

A simultaneous
landing at Les Andalouses 15 miles west of Oran by the 26th RCT, 1st Infantry
Division, was only briefly interrupted by an unexpected sand bar, and the
men were moving inland by daylight when French coastal guns began shelling
the transport area. By the end of the day, elements of the 26th had pushed
beyond Mers el Kébir, and that strongpoint was cut off from the
west and south.

The main point
of attack was in the vicinity of Arzew. There the 1st Ranger Battalion
got ashore undetected just north of the town and quickly seized the two
forts dominating the harbor. The 16th and 18th RCTs of the 1st Division
and the larger portion of Combat Command B were then able to land from
transports moved close to shore. There was no opposition until daylight,
by which time the assault units were well on their way to their first objectives.
Combat Command B raced southwest some twenty-five miles to seize Tafaraoui
airfield and held it against French counterattacks the following day. The
16th and 18th RCTs moved on Oran by parallel

113

routes, the 18th being delayed by
stubborn resistance at St. Cloud before bypassing that town.

A direct assault
on Oran itself was attempted at H plus 2 by two British destroyers carrying
more than 400 combat troops, most of them from the 1st Armored Division,
but both ships were destroyed inside the breakwater and all men aboard
were killed or captured. Equally unsuccessful, though less disastrous,
was an attempted airdrop on Tafaraoui airfield by 556 men of the 2d Battalion,
509th Parachute Infantry Regiment, flying from England. Faulty navigation
and a mix-up in signals dropped a number of the men in Spanish Morocco,
where they were interned. Others dropped at various points far west of
their objective. Only one plane reached the field, but it met with antiaircraft
fire and turned back without dropping its men. Almost half of the paratroopers
were still missing by 15 November.

The end of the
day, 9 November, found the invaders converging on Oran from all sides.
Armored spearheads entered the city the next morning, the 10th, and a cease-fire
order was issued at 1215.

The combat elements
of the Center Task Force received varying degrees of medical support. The
armored column landing west of Oran was accompanied by its own medical
detachment and by a small group from the organic 47th Armored Medical Battalion.
The 26th Regimental Combat Team, 1st Division, which hit the beaches east
of Oran, received medical support from a collecting company and a clearing
platoon of the organic 1st Medical Battalion, and from a detachment of
6 officers, 6 nurses, and 20 enlisted men of the 48th Surgical Hospital.
The 16th and 18th RCT's of the 1st Division, landing at Arzew, were each
accompanied by a collecting company of the 1st Medical Battalion, with
one clearing platoon backing up both regiments. Combat Command B was supported
by Company B of the 47th Armored Medical Battalion, less the detachment
with the western column. Third-echelon support came from the 400-bed 48th
Surgical Hospital and, after the surrender, from the 38th and 77th Evacuation
Hospitals.

Arzew was already
in Allied hands by the time most of the medical personnel came ashore.
About noon of D-day a clearing platoon of the 1st Medical Battalion, although
most of its equipment was still afloat, took over a dirty and inadequate
civil hospital capable of accommodating 75 patients. The French doctors
in attendance remained to care for natives already there, and for French
and native prisoners as they were brought in. Personnel of the 48th Surgical
Hospital came ashore in landing craft during the afternoon, but without
equipment and scattered over a 2-mile area. As soon as the unit was consolidated,
3 of its surgeons and 3 nurses were sent to the civil hospital.7 The
detachment was augmented during the night by 4 operating teams of 2 surgeons
and a nurse each. These teams worked throughout the night of 8-9 November
by flashlight.

The 48th Surgical set up its own
hospital in nearby French barracks on D plus 2, taking over operation of
the

7 "Having
nurses arrive with the 48th Surgical Hospital at Arzew on D-day was very
helpful in caring for the wounded. However, I did not feel afterwards that
the risk was fully justified and would not do it again." Ltr, Col Arnest
to Col Coates, 10 Nov 58, commenting on preliminary draft of this volume.

Arzew civil hospital at the same
time. Equipment and supplies were secured from the British Navy, Army units
in the area, the French, and the 38th Evacuation Hospital--which had arrived
at Arzew on 9 November but was not yet in operation. The 48th Surgical's
own equipment did not come ashore until 13 November. The maximum number
of patients treated at any one time was 480 and included American, British,
French, and native.

About noon of
D-day elements of Company B, 47th Armored Medical Battalion, assisted by
a detachment from the Twelfth Air Force surgeon's office, set up an aid
station in the city hall at St. Leu, four or five miles southeast of Arzew.
The detachment moved to Tafaraoui airfield on 10 November, and the St.
Leu station was turned over to Air Forces control two days later.

On 11 November,
the day after the surrender of Oran, the 38th Evacuation

115

Hospital moved inland to St. Cloud,
where heavy fighting had overtaxed the available medical facilities. While
equipment was being gathered together at the prospective site, surgical
teams from the 38th joined elements of the 1st Division Clearing Company
at the civil hospital in Oran, where about 300 casualties, including survivors
of the ill-fated H plus 2 attempt to land troops in the harbor, had been
turned over by the French authorities. Personnel of the 77th Evacuation
assumed responsibility for the operation of the Oran hospital on 12 November.
The surgical teams of the 38th rejoined their parent unit the following
day when it opened under canvas at St. Cloud.

Responsibility
for evacuation was taken over by the 51st Medical Battalion, which had
arrived with the 77th Evacuation on the D plus 3 convoy. Up to that time
there had been very little evacuation from the combat zone because of the
blocked harbor and the delay in arrival of hospital ships.

In keeping with
the longer and more determined French resistance, combat casualties of
the Center Task Force were considerably higher than those in the Algiers
area. Of the 620 U.S. patients hospitalized during the week ending 14 November,
456 had combat wounds, 51 had injuries, and 113 were disease cases.8

Western Task Force

The Western Task
Force made three separate landings along more than 200 miles of the Atlantic
coast on both sides of Casablanca, at Safi, Fedala, and Port-Lyautey. These
landings encountered the most determined opposition of any of the three
task forces. Subtask Force BLACKSTONE, commanded by Maj. Gen. Ernest N.
Harmon of the 2d Armored Division and built around the 47th Regimental
Combat Team, 9th Division, and two battalion landing teams of the 2d Armored,
touched shore at Safi, 140 miles south of Casablanca, about 0445, 8 November.
The first waves met only intermittent small arms fire, but the French had
been alerted by the earlier landings inside the Mediterranean.9

When the destroyer
USS
Bernadou
slipped into Safi harbor with a battalion landing team
of the 47th Infantry aboard, she met raking cross fire. USS Bernadou
replied
successfully and managed to land the men, who quickly swarmed into the
town. The destroyer USS Cole followed with more combat troops, but
by this time coastal guns from a nearby fort were sweeping the transport
area. The battleship USS New York replied, and the guns were silenced.
The beachhead

and harbor area were sufficiently
secure by midmorning to bring tanks ashore, and the town surrendered at
1530, about eleven hours after the action had started.

French planes
from Marrakech came over Safi in the early morning of D plus 1, but heavy
fog kept all but one plane from dropping bombs. The one plane destroyed
an ammunition dump, with considerable damage to port installations. Allied
carrier-based planes neutralized the Marrakech field that afternoon

117

and broke up a truck convoy carrying
French reinforcements to Safi. Tanks of Combat Command B, 2d Armored Division,
which had landed during the night of 8-9 November were immediately dispatched
to engage the French column. There was sharp fighting in the vicinity of
Bou Guedra in the late afternoon of 9 November and early the next morning.
After dark on the 10th the tanks withdrew and started for Casablanca, where
they were sorely needed.

The largest of
the three subtask forces--BRUSHWOOD--landed at Fedala, about fifteen miles
north of Casablanca. (Map 8) The force consisted of the 3d Infantry
Division, reinforced by a battalion landing team of the 2d Armored Division
and was commanded by Maj. Gen. Jonathan W. Anderson of the 3d Division.
Fedala lies on the southern edge of a shallow bay, enclosed by Cap de Fedala
jutting out behind the town and the Cherqui headland about three miles
to the northeast. The landing beaches actually used were all inside the
bay, and all within range of batteries on cape or headland. Fortunately,
the defenders were taken by surprise. Despite inexpert handling of landing
craft that took several waves of assault troops to beaches miles north
of the objective and piled many of the small boats onto rocks, there were
3,500 troops ashore before dawn brought organized French resistance. All
initial objectives were quickly seized and the beachhead was secure by
sunrise.

The batteries
were silenced later in the day, and BRUSHWOOD Force began to move inland,
swinging south toward Casablanca. The movement was hampered by delays in
unloading transport and communications equipment, and supporting weapons,
as well as by French resistance, but the force was poised in the outskirts
of Casablanca by midnight of 10-11 November. In the interval, French warships
at Casablanca, including the battleship Jean Bart, had joined the
fight, inflicting considerable damage on the supporting naval units before
being blockaded in the harbor. The final attack on Casablanca had still
not been launched when word arrived that the French were willing to lay
down their arms.

Most vigorously
contested of all the Western Task Force landings were those of Subtask
Force GOALPOST in the Mehdia-Port-Lyautey area, commanded by Maj. Gen.
Lucian K. Truscott, Jr.
(See Map 8.) GOALPOST'S primary mission
was to seize an airfield where P-40's, brought on the carrier USS Chenango,
could
be based to aid in the assault on Casablanca some 75 miles to the southwest.
The airfield lay in a bend of the Sebou River, with the town of Port-Lyautey
south of it, on another and sharper bend. The airfield was about 3.5 miles
inland, or twice that far up the winding river, with the town another 3
or 4 miles upstream, but about equidistant from the coast as the crow flies.
The village of Mehdia was just above the mouth of the river, which was
closed beyond that point by a boom.

The landing force
consisted of the 60th RCT of the 9th Division and a light tank battalion
of the 66th Armored Regiment, 2d Armored Division, with supporting units
that included nearly 2,000 ground troops of the XII Air Support Command.
Landings on both sides of the river mouth were marred when a number of
boat crews missed their beaches, landed the men as much as five miles out
of position, and lost many boats in the

surf. French authorities, moreover,
had been alerted, like those at Safi, by the President's broadcast and
by news of the actions already in progress at Oran and Algiers.

Coastal batteries
opened up after the first wave reached shore, and French planes strafed
the beaches at dawn. Ground opposition increased as the day advanced, and
darkness found only the 3d Battalion of the 60th RCT more than a mile inland,
opposite the airfield but north of the river. Units landing south of the
river converged toward the airfield the following day and one company of
the 3d Battalion crossed the Sebou in rubber boats, but all units were
stopped short of their objectives.

The airfield was
taken early on 10 November when the destroyer USS Dallas rammed
the boom and carried a raiding party up the river to take the defenders
of the field from the unprotected flank. About 1030, planes from the USS
Chenango
began
landing at the field. There was little fighting the rest of that day, and
French resistance was formally ended at 0400 on D plus 3.

For medical support
the Safi force, in addition to attached personnel, was accompanied by a
collecting company of the 9th Medical Battalion and a detachment of the
56th Medical Battalion consisting of two officers and sixty-nine enlisted
men. During the first hours, casualties were held at aid stations for which
sand dunes furnished the only cover. Early capture of the waterfront area
made it possible to establish aid and collecting stations in a warehouse
on the dock about H plus 8. From this point, casualties were evacuated
for temporary hospitalization aboard the USAT
Titania. Two days
after the assault began, an improvised hospital staffed by medical battalion
personnel was in operation in a school building with equipment borrowed
from local doctors and merchants and from the Navy. Patients to be retained
in the theater under a 30-day evacuation policy were brought to this provisional
hospital from as far away as Port-Lyautey.

The 3d Division
and its reinforcing armored battalion at Fedala were supported by the organic
3d Medical Battalion and by a detachment of the 56th Medical Battalion
similar in size and composition to the detachment with the Safi force.
Like the combat troops, medical soldiers were scattered by poor navigation
of the landing craft. Units experienced considerable delay in making contact
with their headquarters, as well as in the matter of receiving supplies.
Evacuation was also a slow and uncertain process until medical units were

119

assembled and vehicles were made
available, and the wounded were held at battalion aid stations for twenty-four
and sometimes thirty-six hours. A clearing station was set up by the afternoon
of D-day in a beach casino at Fedala with capacity for 150 litter cases,
the overflow being cared for in school buildings and private homes. Additional
supplies were borrowed from the Navy. During the night of 12 November the
station cared for survivors of a U-boat attack, including over 400 burn
cases, 100 of them so severe as to require repeated transfusions. Flashlights
furnished the only illumination until floodlights could be borrowed from
Ordnance repair units. All available medical officers, including Colonel
Kenner himself and Lt. Cols. Huston J. Banton and Clement F. St. John of
the headquarters staff, worked through the night at the clearing station.
Supplies and personnel were inadequate, and many of the more severe cases
were lost.10

The Mehdia landings
were supported by a collecting company and a clearing platoon of the 9th
Medical Battalion and a detachment of the 56th Medical Battalion. The medical
force was about half the size of those with the other two sub-task forces.
Throughout the three days of fighting it was possible to do no more than
set up beach aid stations. Evacuation by land was out of the question for
want of vehicles and a place to go; evacuation to the transports was hazardous
and at times impossible because of heavy seas and the excessive loss of
landing craft in the assault. On 12 November, after the armistice, the
clearing platoon took over a Red Cross hospital in Mehdia, which was operated
as an evacuation hospital until the regular installations arrived nearly
a month later.

For the Western
Task Force as a whole, 694 cases were hospitalized during the first week
of the invasion. Of these, 603 were combat wounds, 43 injuries, and 48
disease.11

Hospitalization
and Evacuation of Task Force Casualties

Hospitalization
and evacuation of task force casualties remained the responsibility of
the force surgeons until the medical section of Allied Force Headquarters
was established in Africa and base section organizations were set up. For
the Western Task Force the provisional hospitals at Safi and Mehdia continued
to operate as long as they were needed. The Safi hospital was still in
operation when the Atlantic Base Section was activated late in December.
The first U.S. Army hospitals to reach western Morocco were the 750-bed
8th and the 400-bed 11th Evacuation Hospitals, which arrived at Casablanca
together on 18 November on the delayed second convoy. The 8th opened three
days later in buildings of the Italian consulate, which soon proved too
small and inadequately equipped. The 11th moved on to Rabat, where it opened
on 8 December, permitting return of the Mehdia Red Cross hospital to civilian
control. The 59th Evacuation, another 750-bed unit, began receiving patients
under canvas at Casablanca on 30 Decem-

ber. The 400-bed 91st Evacuation
was also in the area before the end of the year, but was not established
under task force control. All of these evacuation hospitals functioned
as fixed installations rather than as mobile units.12

In the Oran area
the three mobile hospitals that came in with the combat troops--the 48th
Surgical and the 38th and 77th Evacuation--were supplemented on 21 November
by the 9th Evacuation, with an additional 750 beds, and by the 1st Battalion,
16th Medical Regiment. Since all of its equipment was lost at sea, the
medical battalion operated a staging area for other units until February
1943. The Mediterranean Base Section was activated on 8 December, and fixed
hospitals under base section control quickly supplanted the mobile units
of the Center Task Force, which began staging for the next phase of the
North African campaign.

Aside from the
clearing platoons of the 9th and 109th Medical Battalions, all hospitalization
for the Eastern Task Force was British. Although they were not able to
land on D-day as planned, the 1st and 8th Casualty Clearing Stations were
established promptly after the surrender of the city and, together with
the provisional casualty clearing station being operated by the 159th Field
Ambulance and the clearing platoon of the 109th Medical Battalion, were
able to care for all casualties until a sufficient number of general hospital
beds was established between 15 and 20 November. All British units took
U.S. patients, but the bulk of them went to the 94th General, largest and
best equipped of the British hospitals assigned to the Eastern Task Force.13

Evacuation from
the Western Task Force was by troop transport to the United States. From
the Center and Eastern Task Forces, evacuation was by British hospital
ship to the United Kingdom. There was very little of either, however, before
the period of task force control ended.

Evaluation of TORCH
Medical Service

From the medical
point of view, Operation TORCH was relatively easy only because casualties
were far lower than had been anticipated and because medical officers and
enlisted men of the Medical Department met unexpected situations with ingenuity
and skill. In no instance did the collecting or clearing elements get ashore
early enough, or have enough equipment with them. Supplies hand-carried
by medical personnel accompanying the assault waves included some unnecessary
items and omitted other items that would have been useful. Additional medical
supplies were scattered over the beaches, where quantities were lost. Ambulances,
in particular, were unloaded far too slowly, and when they finally became
available they proved to have poor traction in sand and a dangerously high
silhouette. The jeep, on the other hand, was found to be readily adaptable
for carrying litters over difficult terrain.14

Hospital facilities provided for
the Western Task Force aboard the transports proved unusable except in
a single instance because of the heavy surf and the heavy loss of landing
craft during the assault. Mobile hospitals provided for the Center Task
Force were adequate as to bed strength, but the unloading of equipment
was not co-ordinated with the debarkation of personnel. Hospital equipment,
moreover, often proved to be incomplete when unpacked.15
The
Center and Western forces found it impossible to obtain records of casualties
evacuated by naval beach parties, or even to learn how many there were.

Both the planning
and the execution of the operation were at fault. Those who drew the medical
plans in Washington and London had very little communication with each
other, had only meager intelligence reports as to the conditions they would
actually meet, and were for the most part either without combat experience
on which to base their judgments or had experience limited to the static
warfare of World War I. Medical personnel with the assault troops were
equally inexperienced and at least equally ignorant of what war in North
Africa would be like.

Medical Support
of II Corps in the Tunisia Campaign

Expansion Into Tunisia

Armistice negotiations
were still going on in Algiers and fighting still raged at Casablanca and
Oran when the Eastern Task Force resumed its identity as the British First
Army and turned toward Tunisia. The French commander there was unwilling
or unable to obey Darlans cease-fire order, and Axis reinforcements were
coming in through the ports and airfields of Tunis and Bizerte. First Army
units occupied Bougie, 100 miles east of Algiers, on 11 November. The following
day British paratroops and a seaborne commando group took Bône, 150
miles farther east, unopposed. Advance elements were within 60 miles of
Tunis before encountering German patrols on 16 November. With French co-operation,
forward airfields were occupied in the Tébessa area, just west of
the Tunisian frontier and 100 miles south of the coast. Medjez el Bab was
captured on 25 November. The airfields at Djedeida, a bare 15 miles from
Tunis, were occupied three days later, but could not be held against strong
counterattacks.16

Surg, II Corps, 1942.
(3) Recommendations of Surg, Western Task Force, 24 Dec 42, in Med Annex
to Final Rpt of Opns.
15 "Equipment
was packed and shipped with the notation on the packing case, 'Complete
except for the following items. ' The 'following items' were pieces of
equipment that would deteriorate in storage--particularly rubber items.
These should have been included before shipment as pieces of equipment--notably
anaesthesia machines--could not be used until the missing items had been
received from the U.S. It took many months to make up these deficiencies."
Ltr, Col Bauchspies to Col Coates. 15 Apr 59, commenting on preliminary
draft of this volume. Colonel Bauchspies was commanding officer of the
38th Evacuation Hospital in the North African invasion.
16 Military
sources for the first phase of the Tunisia Campaign are: (1) Field Marshal
the Viscount Alexander of Tunis, "The African Campaign from El Alamein
to Tunis," Supplement to the London Gazette, 5 February 1948. pp.
864-66; (2) Howe, Northwest Africa; (3) Howe,
1st
Armored Division; (4) Craven and Cate, eds., Europe:
TORCH
to POINTBLANK; (5) Albert Kesselring,
Kesselring: A Soldier's
Record
(New York: William Morrow and Company, 1954). The more important
medical sources are: (6) Crew, Army Medical Services: Campaigns; (7)
Clift
Field

122

By early December
General Anderson's troops were exhausted and his supplies critically short.
Before a direct attack on Tunis could be mounted the winter rains set in,
and the campaign bogged down in mud. After a month of futility, during
which the enemy achieved superior build-up by virtue of his larger ports,
all-weather airfields, and shorter supply lines, the front was stabilized
from Medjez el Bab in the north to Gafsa in the south. The First Army dug
in to wait.

The first phase
of the Tunisia Campaign began in mid-November with the piecemeal commitment
of American troops in support of the British First Army. It ended with
the concentration of II Corps in the Constantine-Tébessa area during
early January 1943 in preparation for a large-scale offensive. Immediately
after the armistice elements of the 34th Division that had participated
in the Algiers landings relieved British units occupying Bougie and Djidjelli.
The 39th Regimental Combat Team, 9th Division, was detailed to guard the
line of communications from Algiers to the rapidly advancing front. Elements
of the 9th Medical Battalion that had landed with the 39th RCT operated
an ambulance service and a clearing station in Baba Hassen, some twelve
miles southwest of Algiers. The four teams of the 2d Auxiliary Surgical
Group that had been part of the Eastern Task Force continued to function
in British hospitals and other medical installations close to the front.

As rapidly as
the situation permitted, elements of II Corps that had made up the Center
Task Force were also deployed to eastern Algeria and Tunisia. Combat Command
B of the 1st Armored Division was at the front in time to participate in
the long seesaw battle for Medjez el Bab that began around the first of
December. The 2d Battalion, 509th Parachute Infantry, flown out from Oran,
was operating in the Gafsa area in conjunction with Twelfth Air Force units
and French ground troops. Before the end of December elements of the 1st
Division were also in action in the Medjez el Bab sector. In addition to
attached medical personnel, Company B of the 47th Armored Medical Battalion
was in Tunisia in support of units of the1 Armored Division. The 2d Battalion
of the 16th Medical Regiment which had landed at Oran on 8 December, reached
the front shortly before Christmas on detached service with First Army.17
In
this early phase of the campaign the U.S. forces fought in relatively small
units, with supporting medical detachments correspondingly divided.

Hospitalization
and evacuation in the British First Army area were exclusively British
responsibilities. As the first phase of the Tunisia Campaign came to a
close in muddy stalemate, there were approximately 250,000 Allied troops
under First Army control, for which 11,000 beds in

British military hospitals were available.
Although the bed ratio was thus only 4.4 percent, no serious overcrowding
was observed. Mobile units were close to the front lines and treatment
was prompt. The Western Task Force surgeon, A. W. Kenner, who had been
promoted to brigadier general and assigned to AFHQ as medical inspector,
visited the front between 27 December and 4 January and concluded that
American casualties were receiving the best medical care possible under
the circumstances. He noted, however, that British hospitals were often
lax in forwarding records of U.S. patients, so that commanders lost track
of their men and returns to duty were unnecessarily slow; and that morale
was impaired by absence of mail from home and failure to receive pay, though
British wounded in the same hospitals received both. Other adverse morale
factors were failure to receive the Purple Heart and the loss of personal
toilet articles.

A month later
Brig. Gen. (later Maj. Gen.) Howard McC. Snyder made similar observations,
noting also that forward hospitals were unheated, lacking in all but the
barest essentials in equipment, and understaffed by American standards.
Nevertheless, he found treatment to be of a high order. While some installations
had few patients, others were overburdened, resulting in a highly flexible
evacuation policy. In some instances patients who could have been quickly
returned to duty were sent to the rear simply to make room for new casualties.
In others, men who should have been evacuated were held near the front
because fixed beds were not available for them in the still rudimentary
communications zone.

Evacuation was
by ambulance from aid stations and other forward installations to railheads
at Souk el Khemis, where a clearing platoon of the 2d Battalion, 16th Medical
Regiment, shared the load with a British casualty clearing station, and
at Souk Ahras, where facilities included a casualty clearing station and
a 200-bed British general hospital. Michelin cars with capacity for 14
litter cases ran over the narrow-gauge line from Souk el Khemis to Souk
Ahras; from there three British hospital trains made the 24-hour run to
Algiers. Hospital trains were not yet available for evacuation west of
that city.

In the Tébessa
sector a British casualty clearing station and a small dispensary operated
by the Twelfth Air Force furnished hospitalization. Both installations
were at Youks-les-Bains, a few miles west of Tébessa and adjacent
to a large airfield. Evacuation was by air, but was not formally organized.
Up to early January, most of the casualties flown out were Air Forces personnel.

The Kasserine Withdrawal

At the turn of
the year, U.S. units operating with the British First Army, together with
forces from the Casablanca and Oran areas, were transferred to II Corps
under General Fredendall, and various changes were made in the overall
command structure. General Clark was detached from Allied Force Headquarters
to train the newly activated U.S. Fifth Army for future operations in the
Mediterranean. He was succeeded as Deputy Supreme Commander in North Africa
by General Sir Harold R. L. G. Alexander. Lt. Gen. Sir Bernard L. Montgomerys
British Eighth Army, fighting its way through Libya, was to come under
General Eisenhowers com-

124

mand when it reached the Tunisian
border. A new 18 Army Group was then to come into being, made up of the
British First and Eighth Armies, the U.S. II Corps, and the French 19th
Corps under General Louis-Marie Koeltz. General Alexander was to be the
army group commander.

Early in January
General Fredendall established II Corps headquarters at Constantine and
began moving his forces into the vicinity of Tébessa. Additional
elements of the 1st Armored and 34th Infantry Divisions, as they arrived
from England, were sent to the II Corps sector, while all remaining elements
of the 1st Division were brought up from Oran. The three divisions were
substantially assembled by 1 February, with the scattered regiments of
the 9th Division being moved into position as reserves. Medical units based
around Tébessa included, in addition to attached medical personnel,
the 1st and 109th Medical Battalions and the 47th Armored Medical Battalion,
organic to the combat divisions; the 51st Medical Battalion; the 2d Battalion,
16th Medical Regiment; the 1st Advance Section of the 2d Medical Supply
Depot; the 48th Surgical Hospital; and the 9th and 77th Evacuation Hospitals.18

The Germans seized
the initiative when the rainy season ended in February. Early in the month
Generaloberst Juergen von Arnims army in Tunisia was joined by Field Marshal
Rommels famed
Afrika Korps, and Rommel himself was in command when
the Axis forces attacked savagely toward Faïd Pass in the center of
the II Corps front on the l4th. Intelligence expected the attack farther
north, and the Americans were caught off balance. Fredendall prepared to
stand at Kasserine Pass, some forty miles west of the breakthrough, but
his armor was out of position and poor weather conditions prevented air
support or even reconnaissance. Enemy tank columns forced the pass on 20
February and debouched onto the plain beyond in a three-pronged drive that
reached its maximum extent, only twenty miles from Tébessa, two
days later. There the drive was contained. The Germans, running low on
fuel and ammunition, realized they had not the strength to break through
the Allied lines in the face of reinforcements moving in from Le Kef and
Tébessa, and withdrew to their original positions.

Before the Faid
breakthrough there had been relatively heavy fighting in the

Ousseltia Valley, where the II Corps
sector approached British positions in the north, and around Gafsa, more
than a hundred miles distant on the southern flank. These actions had served
to disperse collecting and clearing companies over hundreds of miles of
rough and largely roadless country. The 9th and 7th Evacuation Hospitals
were about ten miles southeast of Tébessa, far to the rear, while
the 48th Surgical was operating one 200-bed unit at Thala and the other
at Fériana, each more than fifty miles from the combat lines as
of 14 February. (Map 9)

stallations paralleled the mid-February
German advance. On the first day of the advance an entire collecting company
of the 109th Medical Battalion was captured, together with most of the
medical detachment of the 168th Infantry regiment--in all, 10 medical officers
and more than 100 enlisted men. On the same day, 14 February, an officer
of the 47th Armored Medical Battalion was captured with four ambulances
loaded with casualties.19 Aid stations in both Faid and Gafsa
sectors were hastily leapfrogged to the rear, one section caring for patients
while another moved to a safer location. Lines of evacuation were long
and circuitous, over roads that could be safely traveled only at night.
Trucks and litter-jeeps were freely used to supplement the ambulances that
were never available in sufficient numbers.

During the night
of 14-15 February the Fériana section of the 48th Surgical Hospital
moved to Bou Chebka about midway along the road to Tébessa, using
trucks and ambulances of the corps medical battalions. Patients were placed
in the 9th Evacuation Hospital, which shifted 107 of its own patients to
beds set up for the purpose by the still inoperative 77th. By February
17th the 48th Surgical was on the road again, moving this time to Youks-les-Bains
just west of Tébessa. Within six hours of ar-

19 Interv
with 1st Lt Abraham L. Batalion, and Capt Wilbur E. McKee.

127

rival it was receiving patients from
both evacuation hospitals, which were themselves in process of moving.

When weather conditions
made air evacuation to the communications zone impossible, a section of
the British 6th Motor Ambulance Convoy was rushed to Youks, where it was
placed at the disposal of the 48th Surgical Hospital on 18 February. The
twenty-five ambulances and two buses of this unit were able to move 180
patients at a time, and succeeded in clearing the Tebessa area of casualties
by the time the Germans broke through Kasserine Pass. Both the 9th and
the 77th Evacuation Hospitals were back in operation by 20 February, at
new sites in the Ain Beida-La Meskiana area on the road to Constantine.
The Tebessa section of the 2d Medical Supply Depot moved into the same
area on 19 February, followed by the Thala section of the 48th Surgical.
The remainder of the 48th went from Youks to Montesquieu on 22 February,
while the 9th Evacuation shifted from Ain Beida to Souk Ahras, fifty miles
to the north. (Map 10)

All of these moves
were carried out rapidly and in good order, although hundreds of patients
were involved. In this acid test of mobility, commanders were duly impressed
by the fact that a 200-bed section of the 48th Surgical Hospital could
evacuate its patients, dismantle and load its installations, and be on
the road in four and a half hours, while the 750-bed evacuation hospitals,
because they had no organic vehicles of their own, were able to move only
when transportation could be provided by corps. In a disintegrating situation
their priority was low and the danger of their being overrun by the enemy
was proportionately great. The relative immobility of these large units
kept them so far behind the fighting fronts that ambulance runs of a hundred
miles or more between clearing station and hospital were not infrequent.
In the absence of hospitals closer to the lines, teams of the 2d Auxiliary
Surgical Group were attached to the clearing stations.

Operations in Southern
Tunisia

During the first
week of March, General Fredendall was relieved, and command of II Corps
was given to General Patton; Maj. Gen. Omar N. Bradley was appointed his
deputy. The shift in leadership coincided with the penetration of Tunisia
from the south by the British Eighth Army and activitation of the 18 Army
Group under Alexander. The II Corps' next mission was to attack in the
Gafsa-Maknassy area in support of Eighth Army's drive up the coast.20

Mindful of the
Kasserine experience, and with troop strength brought up to 90,000 by assignment
of the 9th Division, Colonel Arnest, the II Corps surgeon, asked for one
of the new 400-bed field hospitals capable of operating in three 100-bed
units, a 400-bed evacuation hospital, and more ambulances. Only the ambulances
arrived before the southern phase of the Tunisia Campaign

was over, and those only a few days
before the pressing need for them had passed. The only medical reinforcements
received were five teams of the 3d Auxiliary Surgical Group, flown in without
nurses on 18 March. Eleven teams of the 2d Auxiliary Surgical Group were
already active in the II Corps area. Shortage of beds made it impossible
to maintain any fixed evacuation policy, even the 15-day policy originally
planned.

The corps jumped off on 17 March.
The1st Division occupied Gafsa the same day, took El Guettar on the 18th,
and seized Station de Sened on the 21th.

129

Maknassy fell to the 1st Armored
on 22 March. After a brief respite for revision of plans and regrouping,
all four divisions of II Corps went into action on 28 March. The 9th Division
attacked along the road from El Guettar to the coastal city of Gabès;
the 1st turned northeast toward Maknassy, where the 1st Armored was concentrating
on a strongly held pass east of the town; and the 34th, together with British
First Army units, attacked Fondouk on the left flank. Fighting in all sectors
was heavy, and for ten days almost continuous. Contact with the British
Eighth Army was established on 7 April, and the enemy began withdrawing
to the north. When the 34th Division and its British allies broke through
at Fondouk two days later, the southern campaign was over.

In the interval
between recovery of the ground lost in the Kasserine withdrawal and the
launching of the II Corps offensive, hospitals and other medical installations
were again moved forward to the Tébessa area. The 9th Evacuation
Hospital set up this time at Youks-les-Bains, where proximity to the field
used for air evacuation to the communications zone was the primary consideration.
Both sections of the 48th Surgical were back at Fériana by 19 March.
Two corps clearing stations established on 22 March remained in place until
the end of the southern campaign, compensating in part for the shortage
of mobile hospital beds. These were the clearing stations of the 51st Medical
Battalion at Gafsa and of the 2d Battalion, 16th Medical Regiment, near
Maknassy. Each was reinforced by surgical teams and was adjacent to clearing
units of the organic medical battalions. They functioned in effect as front-line
hospitals for forward surgery and for holding cases that could not be safely
moved. Evacuation from both stations was to the 48th Surgical Hospital,
fifty miles from Gafsa and almost twice that far from Maknassy.

Coinciding with
the renewal of the offensive on 28 March, the 77th Evacuation returned
to Tébessa and one section of the 48th Surgical went on to Gafsa.
At Sbeitla, on the evacuation route from the 34th Division, 2d Battalion
of the 16th Medical Regiment set up a clearing station that, like the other
two corps clearing stations, functioned as a forward hospital. It was relieved
on 11 April, after the southern campaign had ended, by the 400-bed 15th
Evacuation Hospital.

Facilities of
the 48th Surgical Hospital, and of the corps clearing stations, were wholly
inadequate for the steady stream of casualties from the three divisions
operating in the El Guettar-Maknassy sector during the final drive. Evacuation
to Tébessa and Youks by ambulance and truck was virtually a continuous
process. To make room for new arrivals, the 77th and 9th Evacuation Hospitals
were compelled to send patients to the communications zone with little
reference to their hospital expectancy, and many were thus lost who could
have been returned to duty in a reasonable time.

In the El Guettar-Maknassy
area, terrain was often too rough for vehicles, even for jeeps and half-track
ambulances. Litter carries, especially on the 9th Division front, were
long and generally possible only at night. In many instances both patients
and medical attendants waited in slit trenches for darkness. The corps
medical battalions supplied additional litter bearers, as many as 75 being
needed by one combat team. Only in the

Fondouk sector was evacuation from
the battlefield relatively easy. There, a good road net and adequate cover
permitted location of aid and collecting stations close to the lines. The
ambulance haul from the clearing station at Sbeitla to the evacuation hospitals
at Tébessa and Youks-les-Bains was approximately eighty miles. (Map
11)

The Drive to Bizerte

Following withdrawal
of the enemy from southern Tunisia, General Patton was detached to train
the force that would become the U.S. Seventh Army on the scheduled invasion
of Sicily. Command of II Corps passed to General Bradley, whose first
task was to shift his troops 150 miles to the north. Although the movement
involved passing close to 100,000 men, with all their equipment, across
the communication lines of the British First Army, it was accomplished
without interruption to any supply or military service, and without detection
by the enemy.21

The final phase
of the North African campaign began on 23 April, with II Corps and attached
French elements pushing east along the Mediterranean coast, First Army
advancing northeast in the center, and Eighth Army attacking northward
on the right flank. The French l9th Corps, under General Koeltz, operated
between the two British armies. By this time the Allies had control of
the air and the end was swift and sure. One after another, strongly held
hill positions were stormed. The 1st Armored swept through the Tine Valley
to capture the important communications city of Mateur on 3 May. Bizerte
fell to the 9th Division on 7 May, simultaneously with the entry of British
units into Tunis. The 3d Division was brought up at this time, but was
too late to participate in more than mopping-up operations. All enemy forces
in the II Corps sector surrendered on 9 May. British armor quickly closed
the escape route to the Cap Bon peninsula, and the remaining Axis forces,
trapped between the British First and Eighth Armies,

(Washington, 1943);
(8) Alexander, "African Campaign," Suppl to London Gazette, 5 February
1948, pp. 878-84. Medical sources are substantially the same as those already
cited for the Kasserine and southern phases of the campaign, to which should
be added: (1) Annual Rpt, 10th Field Hosp, 1943; (2) Clift, Field
Opns.

132

surrendered on 13 May. About 275,000
prisoners were taken in the last week of the campaign.

With an independent
combat mission and five divisions under its command by the date of the
German surrender, II Corps resembled a field army both in size and role.
Colonel Arnest functioned more as an army than as a corps surgeon. His
staff of eleven officers and sixteen enlisted men was of a size appropriate
to the responsibilities entailed.

In northern Tunisia,
Tabarka served as the nerve center for medical activities, as Tébessa
had in the south. The use and disposition of mobile hospitals was drastically
modified on the basis of previous experience. The semimobile 400-bed evacuation
hospitals, with surgical teams attached, were placed directly behind the
advancing troops, with the larger evacuation units farther to the rear
where they took patients from the more forward installations. Before the
attack was launched, the 11th Evacuation was shifted more than a thousand
miles from Rabat to a site nine miles south of Tabarka, and the 48th Surgical
was established some ten miles farther to the east. The 750-bed 77th Evacuation
was set up at Morris, near Bône, where it was detached from II Corps
and assigned to the Eastern Base Section, the forward element of the North
African Communications Zone.

On 21 April the
15th Evacuation moved up from Sbeitla to a location ten miles north of
Bédja, and the following day the 11th relieved the 48th Surgical,
which closed for reorganization. The larger 9th Evacuation occupied the
former site of the 11th. (Map 12) The 48th Surgical, converted into
the 400-bed 128th Evacuation Hospital, returned to combat duty southwest
of Mateur on 4 May. The l5th Evacuation, displaced by the 128th, moved
two days later to a site west of Mateur.

The 750-bed 38th
Evacuation Hospital moved from the Télergma airfield west of Constantine,
where it had been operating as a communications zone unit since early March,22
to the vicinity of Bedja on 4 May; and on 7 May the 9th Evacuation moved
forward to the vicinity of Mateur. The 77th Evacuation remained throughout
the campaign at Morris, where it possessed air, rail, and water outlets
to the communications zone, though its usefulness was impaired by an ambulance
run of 85 to 110 miles over roads too rough for the transportation of seriously
wounded men.

In the northern
phase of the campaign, II Corps was thus supported by three 400-bed and
three 750-bed evacuation hospitals, in contrast to the campaign in the
south where one 400-bed unit and two 750-bed units had served substantially
the same troop strength. In the northern campaign, moreover, forward hospitals
were only 5 to 20 miles from the combat areas, contrasted with distances
of 25 to 100 miles in southern Tunisia. Despite these shortened lines of
evacuation, the 2d Battalion of the 16th Medical Regiment and the 51st
Medical Battalion were reinforced by elements of the 56th Medical Battalion
and were given additional ambulances. The 10th Field Hospital, which reached
Tabarka on 30 April, was also assigned to II Corps, but did not go into
operation until 7 May, when it was used exclusively as a holding unit for
air evacuation, and to serve personnel of an air base.

During the first
ten days of the Bizerte drive, fighting was in mountainous country, often
covered with thick, thorny underbrush and largely without roads. Evacuation
was particularly difficult on the 9th Division front, to the left of the
corps sector. For a time mules were used, harnessed in tandem with a litter
swung between poles attached to the saddles. Difficult hand litter carries
up to three and a half miles necessitated the use of 200 additional bearers,
drawn in part from corps medical battalions but mainly from line troops.
At one point, where a railroad cut the 9th Division front, two half-ton
trucks were fastened back to back with rims fitted over the rails. One
truck powered the vehicle on its way to the rear, the other on the return
trip. Twelve litters could be carried at a time, but the exposed position
of the railroad made it usable only at night. One collecting company of
the 9th Medical Battalion operated a rest camp in the rear of the division
area, to which approximately seventy-five front-line soldiers were brought
each evening for a hot shower, a full nights sleep, and a chance to write
letters. Exhaustion cases were held at the clearing stations, under heavy
sedation.

Similar conditions
prevailed on the narrower fronts assigned to the other divisions of II
Corps. The 1st Division borrowed litter bearers from the 51st

134

Medical Battalion; the 1st Armored
drafted cooks, clerks, and other noncombat personnel into service as bearers.
Half-track ambulances proved unable to enter the narrow wadis where casualties
occurred most frequently, and had to be replaced by jeeps. In the bloody
battle for Hill 609, litter bearers of the 34th Division brought out casualties
in daylight from positions closer to the enemy lines than to their own.

In the final week
of the campaign, medical support of the combat forces more closely approximated
the pattern laid down in the manuals. (Map 13) The coastal plain
was adapted to easy movement in vehicles, and the road net was good. The
400-bed evacuation hospitals were closed to admissions between 9 and 15
May, new patients being sent thereafter only to the 9th Evacuation. The
staff of this unit was reinforced by a detachment from the 16th Medical
Regiment and by captured German medical personnel, who helped with prisoner-of-war
patients. Two captured German field hospitals were allowed to continue
in operation, under supervision of the 51st Medical Battalion, until 15
May, when all prisoners still requiring hospitalization were turned over
to the 9th Evacuation. As of 12 May there were 1,145 patients, including
prisoners of war, in II Corps hospitals, and twice that number in the two
evacuation hospitals assigned to the Eastern Base Section. All hospital
units and corps medical battalions passed to control of EBS as of midnight,
15 May.

Immediately after
the end of hostilities the 9th Evacuation Hospital, on its own initiative,
began to function as a station hospital for all troops in the area. Members
of the hospital staff were soon treating 100 or more a day in the outpatient
clinic, where their specialized skills made up for the limitations of battalion
medical sections left with the combat and support troops in the vicinity.23

Summary of Tunisian
Experience

Like the combat
troops, the medical units and personnel of the medical detachments went
into the Tunisia Campaign without battle experience, or with experience
limited to the two or three days of action in the TORCH landings. Deficiencies
in training had to be made up while operating under combat conditions,
and in intervals when the units were in bivouac. More important still was
the training of replacements. Virtually no trained medical replacements
were available, yet losses were high. More than a hundred Medical Department
officers and men were captured in the Faïd Pass breakthrough alone,
while disease, injury, and battle wounds also took their toll. Indeed,
the personnel problem was perhaps the most difficult one faced by the surgeons
office during the campaign. Constant juggling of medical officers, and
continuing training of line troops as replacements, were necessary to keep
the II Corps medical service in operation at all. Other difficulties included
much obsolete equipment in the early stages of the campaign, and generally
inadequate lighting and power facilities.

Casualties were progressively heavier

23 Recorded
interv, Col Coates, with ASD Frank B. Berry, 4 Nov 58, commenting on preliminary
draft of this volume. Dr. Berry--then a colonel-- was chief of the Surgical
Service, 9th Evacuation Hospital, in North Africa.

with each stage of the campaign.
Hospital admissions for the period 1 January through 16 March were 4,689.
During the campaign in southern Tunisia, 17 March through 9 April, 6,370
men were admitted to II Corps hospitals. For the northern campaign, 10
April through 15 May, there were 8,629 hospital admissions. The consolidated
casualty figures, shown in Table 1, offer tangible evidence of the magnitude
of the task successfully carried through by Colonel Arnest and his staff.

The early use
of the 750-bed evacuation hospital as a forward unit was a holdover from
the relatively static warfare of World War I, and was at least in part
responsible for the siting of hospitals so far to the rear. Another reason
for the failure of II Corps to give close hospital support in the Kasserine
and southern phases of the campaign was the absence of any fixed battle
line and the necessity of giving ground before an enemy superior both in
numbers and in combat experience.24

The organization
of the corps medical service underwent numerous changes as the campaign
progressed and more experience was gained with the requirements of modern
combat. Initially the corps surgeon's office was located at the

corps rear echelon, where information
filtered back too slowly to permit adequate advance planning. Delay in
establishing a base section close to the combat zone complicated both supply
and evacuation problems in the early stages of the campaign. The 61st Station
Hospital, located at El Guerrah just south of Constantine early in February
at the request of the British First Army surgeon and under British control
until March, was the only U.S. fixed hospital closer than Algiers until
the end of March. This 500-bed unit, and the British 12th Casualty Clearing
Station at Youks-les-Bains, aided immeasurably in the orderly withdrawal
of II Corps medical installations at the time of the Kasserine breakthrough.
The contrast between the medical support available to the corps at that
time and that available during the final phase of the campaign in late
April and early May shows how quickly and how well the lesson of Kasserine
Pass was learned.25

Air Force Medical
Installations

In addition to
the mobile hospitals serving II Corps in the field, the Twelfth Air Force
maintained various installations of its own, which gave first- and second-echelon
medical service to combat fliers, their counterparts in the Air Transport
Command, and the supporting ground crews. Air Forces medical personnel
were administratively distinct from the organization serving the ground
forces, although the two groups worked closely together. Air Forces installations
were confined to squadron aid stations and dispensaries, but both types
of unit frequently had to assume hospital functions. At the more important
airfields, such as Marrakech, La Sénia, and Télergma, hospitals
were set up by the base sections, while combat zone airfields, such as
Youks-les-Bains, generally had

mobile hospital units of the ground
forces in the immediate vicinity. Fixed hospitals in the communications
zone served Air Forces personnel as well as ground troops.26

Evacuation From
II Corps

The chain of evacuation
from the Tunisian battlefields went from forward evacuation hospitals by
ambulance and rail to Eastern Base Section installations, and by air direct
to fixed hospitals in Algiers and in the vicinity of Oran. During the Kasserine
and southern Tunisian campaigns, Tébessa and the nearby airfield
at Youks-les-Bains served as the starting points for evacuation to the
communications zone. In the final stages of the campaign, and the readjustment
period immediately following the close of hostilities, evacuation was from
Tabarka to Bone, from the railhead at Souk el Khemis to Constantine, and
from

26 For description
of Air Forces medical units, see Link and Coleman, Medical Support of
the Army Air Forces in World War II, pp. 455-57.

138

airfields at Souk el Arba and Sidi
Smaïl to Oran.

Evacuation by Road
and Rail

The 1st Battalion
of the 16th Medical Regiment, with the assistance after 18 February of
the British 6th Motor Ambulance Convoy, operated an ambulance shuttle from
Tébessa to Constantine, approximately 140 miles. The same road served
as a main supply route for II Corps. Beginning in mid-March, the 16th Medical
Regiment also staffed and operated a French hospital train, which ran from
Tébessa to Ouled Rahmoun, just south of Constantine, where the narrow-gauge
Tébessa line intercepted the main east-west railroad. A traffic
control post at Aïn Mlilla distributed patients from ambulance convoys
and hospital trains to vacant beds in the area. In the northern sector
the ambulance route of the 16th Medical Regiment ran eighty-five miles
from Tabarka to Bône. Rail evacuation from the northern sector was
by two British hospital trains from Souk el Khemis, each with capacity
for 120 litter and 200 sitting patients.27

Evacuation from
the combat zone by road and rail was under control of II Corps, although
the 1st Battalion of the 16th Medical Regiment, which was primarily responsible
for the operation, was assigned to the Eastern Base Section. For the Kasserine
period, 1 January to 16 March 1943, the II Corps Surgeon reported 1,740
patients evacuated to the communications zone by road, none by rail. During
the campaign in southern Tunisia, 17 March to 9 April, 1,742 patients were
evacuated by road and 1,052 by rail. From the northern sector, 10 April
to 15 May, the evacuation figures included 5,628 by road and 436 by rail.

Air Evacuation From
II Corps

With the concentration
of II Corps in the Tébessa area in January, it was immediately clear
that the informal and infrequent use of air evacuation prevalent up to
that time would be inadequate. The logistical demands upon the single-track,
narrow-gauge rail line and the one motor road between Tébessa and
Constantine would preclude the extensive use of either for evacuation,
even had hospital cars and ambulances been available at that early stage
of the campaign. In an effort to solve the evacuation problem, General
Kenner and Colonel Corby met with General Doolittle and Colonel Elvins,
respectively commanding officer and surgeon of the Twelfth Air Force, and
the corresponding officers of the 51st Troop Carrier Wing in Algiers on
14 January.28

A comprehensive
plan for air evacuation was agreed upon, and was put into

effect without delay. It differed
in fact but little from the plan Colonel Elvins had prepared before the
invasion, but at that time it had met with a cold reception from ground
surgeons, who believed air evacuation to be impractical. The plan called
for the corps surgeon to establish holding hospitals near forward airfields,
with the air surgeon responsible for supervision and the theater surgeon
for over-all co-ordination. It was in this connection that the 38th Evacuation
Hospital was established at Télergma. 29

The planes used
were C-47's, equipped with litter supports, which made it possible to carry
18 litter patients and attendants. There were no regular schedules, since
the planes were used for evacuation only on their return runs after discharging
cargo or passengers in the combat zone. Requests were made through the
medical section, AFHQ, and evacuation officers in the combat areas were
notified each evening as to how many planes would be available the following
day. Communication was by teletype, telephone, radio, and air courier.
Patients were assembled near the airfields so they could be loaded with
a minimum of delay.

Although planes
were not marked with the Geneva Cross, and flew at low altitudes, there
were no enemy attacks. Before 10 March the medical personnel handling air
evacuation were enlisted men from the medical sections of various groups
of the 51st Troop Carrier Wing. After that date personnel--including nurses
as well as enlisted men--were supplied by the 802d Medical Air Evacuation
Transport Squadron. Surgeons on the ground supervised loading and unloading.
The surgeon of the 51st Troop Carrier Wing was responsible for records,
supplies used in flight, and property exchange. The ratio was two planes
used for resupply for every ten loads of patients, although one plane could
be made to serve if returning personnel were dispersed among cargo transports.

In the Kasserine
phase of the campaign, air evacuation was from Youks-les-Bains, with the
British 12th Casualty Clearing Station serving as holding unit for evacuees.
During the II Corps operations in southern Tunisia the same airfield was
used, with the holding function shifted to the 9th Evacuation Hospital.
One planeload of 16 patients was flown direct from Thèlepte. When
operations shifted to the northern sector, the lines of evacuation ran
from Souk el Arba and Sidi Smaïl. The 38th Evacuation Hospital was
close to both airfields. In the final days of the campaign, the 10th Field
Hospital served as a holding unit at Souk el Arba. The overcrowded hospitals
of the Eastern Base Section were bypassed, the planes returning directly
to their own bases at Algiers and Oran, sometimes by an inland route and
sometimes flying low over the water. Figures for air evacuation from the
Tunisian fronts between 16 January and 23 May 1943, as reported by the
802d Medical Air Evacuation Transport Squadron (MAETS), are broken down
by points of origin and destination in Table 2.

The Air surgeon
estimated that 887 patients had been evacuated by air in North Africa before
the formal service was inaugurated on 16 January 1943, but

It was this experience
in North Africa that gave both ground and air surgeons some idea of the
immense capabilities of air evacuation, which continued to be used increasingly
through the rest of the war.

Medical Supplies
and Equipment

Shipping shortages
and the speed with which Operation TORCH was mounted held medical supplies
and equipment carried by the task forces to the lowest possible level consistent
with safety. There also were difficulties in getting together all of the
items scheduled for follow-up convoys. Hospitals destined for North Africa
arrived in England with no more than 25 percent of their medical equipment
and none of their quartermaster equipment. Deficiencies were made up in
the United Kingdom, but only by stripping the European theater of much
of its reserve stock.31

Until the arrival
of trained medical supply personnel late in December 1942, supplies for
the Western Task Force were handled by division medical supply officers
and by personnel of a hospital ship platoon. For the Center Task Force,
the 51st Medical Battalion took over the medical supply function shortly
after its arrival on the D plus 3 convoy. Here trained medical supply personnel
were available within two weeks. The 1st Advance Section, 2d Medical Supply
Depot, arrived in Oran on 21 November and carried on the medical supply
func-

30 The II
Corps surgeon, in his annual report for 1943, gives a figure of 3,313 patients
evacuated by air between January and 15 May. The larger figure shown in
Table 2 is due in part to the additional week included at the heavy end
of the period, and in part to the inclusion of Air Forces casualties, not
reported by II Corps.
31 Ltr,
Brig Gen Paul R. Hawley, Surg, ETOUSA, to Col Corby, 5 Nov 42. Except as
otherwise noted, primary sources for this section are: (1) Med Hist,
2d Med Supply Depot Co, 1942, 1943; (2) Annual Rpt, Surg, II Corps,
1943; (3) T Sgt William L. Davidson, Medical Supply in the Mediterranean
Theater of Operations. United States Army, pp.1-29; (4) Rpt of Med
Supply Activities, NATOUSA, Nov 42-Nov 43.

tion for the growing body of troops
in the area until a base section organization was established early in
December.
32

The U.S. components
of the Eastern Task Force were supplied, like the British components, through
the British First Army. Even items not available in British depots were
requisitioned from ETO sources by the British. This dependence upon British
supplies continued through the first phase of the Tunisia Campaign, creating
many difficulties because of differences in practice between the two medical
services. Supply levels deemed adequate by the British were insufficient
by the more lavish American standards.33

Medical supply
in Tunisia passed into American channels with the concentration of II Corps
in the Constantine-Tébessa area at the beginning of 1943. The 1st
Advance Section of the 2d Medical Supply Depot opened in Constantine on
8 January, moving a few days later to Télergma, where it relieved
elements of the 16th Medical Regiment. The section shifted to Bekkaria,
east of Tébessa, on 20 January, and thereafter remained as close
as possible to the II Corps medical installations. The supply depot withdrew
to Am Beida on 20 February, following the Kasserine breakthrough, then
moved up to Souk Ahras for a brief time, but was back at Bekkaria before
the Gafsa-Maknassy-El Guettar campaign began in mid-March. The depot was
in operation east of Tabarka by 23 April in support of the drive to Bizerte.
On 15 May, immediately after the German surrender in Tunisia, the 1st Advance
Section, 2d Medical Depot Company, moved to Mateur, where it was later
relieved by a base section depot.

After activation
of the Eastern Base Section late in February, medical supplies for II Corps
were received through the base depot at Aïn Mlilla, south of Constantine,
or one of the two subdepots at Philippeville and Bone. Distance and transportation
difficulties always complicated the supply problem, but there were no serious
shortages of any necessary item at any time during the Tunisia Campaign.

Medical supplies
in North Africa were furnished initially on the basis of the Medical Maintenance
Unit (MMU), designed to meet the medical requirements of 10,000 men for
thirty days. Deliveries to the theater were automatic, determined by troop
strength. Combat experience quickly revealed deficiencies and overstocks
in the MMU, which was supplanted midway through the Tunisia Campaign by
the Balanced Depot Stock, worked out by supply experts in the Office of
The Surgeon General.

Items of basic
equipment were the most difficult to replace, but in spite of depot stringencies,
hospitals assigned to the combat zone usually managed to get there with
equipment in excess of their organizational allowances, and so were able
to weather loss and breakage.

Professional Services

Combat Medicine
and Surgery

The amphibious phase of the North
African campaign was too brief, and the

nature of the fighting too restricted,
to provide positive experience in combat medicine and surgery. The primary
lesson for the Medical Department was the necessity in future landing operations
of establishing clearing stations and hospitals ashore at the earliest
possible date, with sufficient equipment and adequate personnel for emergency
surgery and medical care. In Tunisia, invaluable experience was gained
in the management of wounds, in the equipping and staffing of facilities
for forward surgery, and in the handling of psychiatric cases. Even before
the campaign was over, much of this experience was applied toward the improvement
of medical and surgical care in the combat zone.

Forward Surgery-
In
the early phases of the Tunisia Campaign, mobile hospitals were located
so far to the rear--often 50 to 100 miles--that a far heavier surgical
load fell on the clearing stations than had ever been contemplated. Plasma
as a guard against shock was given in the collecting stations and often
in the aid stations, but as a general rule only emergency surgery was performed
in the division area. Surgeons in the division clearing stations administered
plasma, controlled hemorrhage, and closed sucking chest wounds, but completed
trau-

144

matic amputations only where necessary
to stop hemorrhage.34

After emergency
treatment, surgical cases went to the clearing stations of the corps medical
battalions, which were set up through necessity as forward surgical hospitals
despite the fact that they were inadequately equipped and staffed for this
purpose. Surgical and shock teams worked together effectively in these
installations with minimal equipment, but there were neither beds nor personnel
for postoperative care. Intravenous fluids could not be administered; special
diets were not available; whole-blood transfusions were possible only with
detachment personnel as donors and without means of checking blood for
malaria or syphilis. As a result, patients were evacuated as rapidly as
possible, the majority in six to eight hours after surgery and some while
still under anesthesia.

Col. Edward D.
Churchill, surgical consultant in the theater, explored the situation during
the southern campaign, and his recommendations had much to do with the
improvement of conditions in the northern sector, where smaller evacuation
hospitals were set up closer to the front. Associated with Colonel Churchill
in the evaluation of II Corps surgery was Maj. (later Col.) Howard E. Snyder,
of the 77th Evacuation Hospital, who reported to corps headquarters for
temporary duty on 15 March 1943, and remained as surgical consultant to
the corps.35
In the Sicily Campaign, as will be seen later,
the whole concept of forward surgery was altered as a result of the Tunisian
experience.

One of the lessons
quickly driven home in the Tunisia Campaign was that plasma was not a complete
substitute for blood in combat surgery. No supply of whole blood was available,
nor had any provision been made to fly it in. To meet the immediate and
pressing need, an informal blood bank was established at the Gafsa section
of the 48th Surgical Hospital, where 25 to 50 troops were detailed each
day as donors. Out of the II Corps blood bank of 1943 grew the theater
blood bank of 1944.36

The Psychiatric
Problem-
The outstanding medical problem of the Tunisia Campaign was
the unexpectedly high incidence of psychiatric disorders. Originally diagnosed
as shellshock, following World War I terminology, or as battle fatigue,
these cases constituted a heavy burden on forward medical units. In the
absence of specialized knowledge on the part of regimental and division
medical personnel, most of the psychiatric cases in the early stages of
the campaign were evacuated to communications zone hospitals, from which
less than 3 percent returned to combat duty.37

In the battles
of El Guettar and Maknassy in southern Tunisia, psychiatric reactions were
responsible for 20 percent of all battlefield evacuations, and for days
at a time the proportion ran as high as 34 percent 38 Experimenting
with these cases at the corps clearing station near Maknassy late in March
1943, Capt. (later Col.) Frederick R. Hanson, who had been sent out from
the theater surgeons office to investigate the problem, found that 30 percent
of all psychiatric cases could return to full duty within thirty hours
if properly treated close to the combat lines. The treatment Captain Hanson
developed was heavy sedation at the clearing station, followed by transfer
to an evacuation hospital where sedation and intensive psychotherapy were
continued for three days. At the end of that time, the patient was returned
to duty or was evacuated to the communications zone for further treatment.

In the Bizerte
phase of the campaign, division surgeons were made responsible for the
initial treatment, and psychiatrists for the follow-up were attached to
the 9th, 11th, 15th, and 128th Evacuation Hospitals, all functioning in
the forward area. Hanson himself was attached to the 48th Surgical Hospital,
later reorganized as the 128th Evacuation. Cases returned to full duty
without leaving the combat zone ranged from 58 to 63 percent.

Common Diseases-
Aside
from surgical and psychiatric problems, the Tunisia Campaign revealed little
of a medical nature that had not been anticipated. Dysentery and diarrhea
were prevalent among II Corps troops, but outbreaks were controlled by
screening and by destruction of flies. Respiratory infections were a frequent
occurrence, but were not particularly severe. Malaria was not a source
of difficulty, since the campaign ended before the onset of the malaria
season, and combat exposure was therefore not extensive. As a preventive
measure, II Corps troops began taking atabrine on 4 April, with good compliance
and minimal reactions.

Dental Service

The Tunisia Campaign
revealed that the standard dental chest was not sufficiently portable to
be carried close behind the lines. During periods of com-

38 This
terminology requires some explanation. Although the terms "casualty" and
"battle casualty" were consistently applied in the Mediterranean theater
to psychiatric disorders occurring in the combat zone, these cases are
officially tabulated as "disease." Not to establish a new policy but to
make explicit one supposedly already in effect, War Department Circular
No. 195, dated 1 September 1943, stated: "Psychoneurosis or mental diseases
developing under battle conditions (commonly but improperly designated
battle neurosis, hysteria, shellshock, etc.) will not be classified as
a battle casualty or reported as wounded or injured in action." By that
date, however, the practice in the theater had become fixed, as will be
seen from the documents cited in the preceding footnote. As late as 1949,
Colonel Hanson and his collaborators were still employing the term "psychiatric
casualty" in the sense in which they had used it prior to September 1943.
For the sake of uniformity, all psychiatric disorders will be statistically
treated as "disease" in this volume; but in deference to views widely held
among psychiatrists, the term "disease" will not be used in the text to
categorize cases falling under the general classification of "combat exhaustion."

146

bat, cases requiring emergency dental
treatment were cared for at division clearing stations, and as much routine
work as possible was done in the division area. For the most part, however,
the routine work was deferred until periods of combat inactivity. During
periods of actual contact with the enemy, when little dental work could
be done, dental personnel usually served in other capacities such as assistant
battalion surgeon; supply, mess, records, motor, and admissions officer;
and anesthetist. Enlisted dental technicians served as medical technicians
and as company aid-men.39

A need for dental
prosthetics was observed throughout the Tunisia Campaign, but no facilities
for such work were available in the II Corps area, and only inadequate
facilities appeared anywhere in the theater. The 34th Division dental surgeon
found a partial solution of this problem in March when captured German
equipment was used to set up a prosthetics laboratory for the division.40

Veterinary Service

The veterinary
service of II Corps during the Tunisia Campaign was largely confined to
routine food inspections by division veterinarians. Since no fresh meat
was available until April, the duties were not arduous, and veterinary
personnel, like dental personnel, were frequently used in administrative
and other capacities. Veterinary functions included the care of animals
only for a brief interval in late April when mules were used for evacuation
of the wounded in die 9th Division area. The veterinary officer attached
to the Twelfth Air Force headquarters in Algiers carried on food inspection
work for the air force units.41